左侧中央前回腹侧部胶质瘤的手术切除和预后分析  

Surgical resection and prognostic analysis for gliomas in the left ventral precentral gyrus

作　　者：郝小桃 马耐耐 周裕瑶 路俊锋 Hao Xiaotao;Ma Nainai;Zhou Yuyao;Lu Junfeng(Department of Neurosurgery,Huashan Hospital,Shanghai Medical College,Fudan University,Shanghai 200040,China;Brain Function Laboratory,Neurosurgical Institute of Fudan University,Shanghai 200040,China;National Center for Neurological Disorders,Huashan Hospital,Shanghai Medical College,Fudan University,Shanghai 200040,China)

机构地区：[1]复旦大学附属华山医院神经外科,上海200040 [2]复旦大学神经外科研究所脑功能实验室,上海200040 [3]国家神经疾病医学中心(华山),上海200040

出　　处：《中国微侵袭神经外科杂志》2025年第1期45-51,共7页Chinese Journal of Minimally Invasive Neurosurgery

摘　　要：目的 探讨左侧中央前回腹侧部(ventral precentral gyrus,vPrCG)胶质瘤的手术切除策略,评价左侧vPrCG胶质瘤切除后患者的生存预后及语言功能。方法 回顾性分析19例左侧vPrCG胶质瘤患者临床资料。术前采用多模态影像导航融合与重建技术进行手术计划;术中采用唤醒麻醉联合语言皮质及皮质下定位技术定位并保护语言功能区,并在导航及术中磁共振辅助下对肿瘤行最大范围安全切除;术后定期随访患者语言功能预后及生存预后情况。结果 19例患者中,术前失语10例(52.6%),术后1个月失语17例(89.5%),术后3个月失语12例(63.2%),2例(10.5%)患者出现新发远期失语。自发言语、复述、理解和命名这四个语言亚项评分在术后1个月均明显下降,在术后3个月呈现一定程度恢复,但自发言语和命名功能恢复相对较差。低级别胶质瘤(low-grade glioma,LGG)和高级别胶质瘤(high-grade glioma,HGG)患者的语言功能预后无显著差异。19例患者肿瘤平均切除程度为89.7%,14例(73.7%)患者达到完全或近全切除(切除范围≥90%)。低级别胶质瘤组(10例)肿瘤平均切除程度为85.6%,随访时间14~114个月,中位无进展生存期(progression free survival,PFS)和中位总生存期(overall survival,OS)分别为77个月和未达到;高级别胶质瘤组(9例)肿瘤平均切除程度为94.4%,随访时间13~88个月,中位PFS和中位OS分别为18个月和47个月。结论 针对左侧vPrCG这一相对手术禁区,在多模态影像导航的辅助下,采用唤醒麻醉联合语言功能区定位与保护技术,能够实现最大程度安全切除,进而达到功能预后和生存预后的平衡。Objective To explore the surgical resection strategy of the left ventral precentral gyrus(vPrCG)glioma,and to evaluate the survival prognosis and language function of patients after resection of the left vPrCG gliomas.Methods The clinical data of 19 patients with left vPrCG gliomas were analyzed retrospectively.Preoperatively,multimodal imaging navigation fusion and reconstruction techniques were used for surgical planning.Intraoperatively,awake anesthesia combined with language cortex and subcortical localization techniques were used to locate and protect the language function area,and the tumor was safely resected to the maximum extent with the assistance of navigation and intraoperative magnetic resonance imaging.Postoperatively,the patients were followed up regularly for language function prognosis and survival prognosis.Results Among the 19 patients,10(52.6%)had preoperative aphasia,17(89.5%)had aphasia 1 month after surgery,12(63.2%)had aphasia 3 months after surgery,and 2(10.5%)patients had new long-term aphasia.The scores of the four language sub-scores of self-speech,repetition,comprehension and naming all decreased significantly at 1 month after operation,and showed a certain degree of recovery at 3 months after surgery,but the recovery of self-speech and naming function was relatively poor.There was no significant difference in the prognosis of language function between patients with low-grade glioma(LGG)and high-grade glioma(HGG).The average degree of tumor resection in 19 patients was 89.7%,and 14 patients(73.7%)achieved complete or near-total resection(resection extent≥90%).In the LGG group(10 cases),the average degree of tumor resection was 85.6%,the follow-up time was 14-114 months,and the median progression-free survival(PFS)and median overall survival(OS)were 77 months and not reached,respectively.The average degree of tumor resection in the HGG group(9 cases)was 94.4%,the follow-up time was 13-88 months,and the median PFS and median OS were 18 months and 47 months,respectively.Conclusions For

关 键 词：神经胶质瘤 左侧中央前回腹侧部 手术策略 语言功能 生存预后 

分 类 号：R739.41[医药卫生—肿瘤] R730.264[医药卫生—临床医学]